超未成熟儿的生存状况与预后影响因素分析  

Analysis of survival and prognostic factors in extremely preterm infants

作　　者：崔银珠[1] 张谦慎[1] 贺红云[1] 陈春[1] 

机构地区：[1]南方医科大学附属深圳妇幼保健院新生儿科,广东深圳518028

出　　处：《中国当代儿科杂志》2014年第6期596-600,共5页Chinese Journal of Contemporary Pediatrics

摘　　要：目的探讨胎龄28周以下超未成熟儿在新生儿重症监护病房(NICU)的存活率、住院期间并发症发生情况及其预后。方法收集2011年1月至2013年3月入住NICU的胎龄<28周早产儿90例,回顾性分析围产期资料、出生及复苏史、住院期间通气/氧疗情况,以及严重脑室内出血(IVH)、支气管肺发育不良(BPD)、早产儿视网膜病(ROP)、动脉导管未闭(PDA)、败血症等的发生率。结果 90例患儿平均胎龄26±1周,出生体重898±165 g,总存活率为57%,病死率9%,放弃率34%。常见并发症包括新生儿呼吸窘迫综合征(RDS)88%、BPD 85%、PDA 69%,ROP 68%,Ⅲ、Ⅳ级IVH 31%;存活早产儿平均住院时间为83±18 d,出院平均体重为2 419±300 g。多因素logistic回归分析发现,肺出血与严重IVH为死亡或放弃的高危因素,产前使用糖皮质激素为保护因素。结论目前国内超未成熟儿存活率相比发达国家仍有较大差距;肺出血、严重IVH为影响预后的重要因素。Objective To investigate the survival rate,complications during hospitalization,and prognostic factors in extremely preterm infants（gestational age less than 28 weeks） in the neonatal intensive care unit（NICU）.Methods A retrospective analysis was performed on 90 extremely preterm infants who were admitted to the NICU between January 2011 and March 2013 to investigate the perinatal data,delivery and resuscitation,ventilation/ oxygen supply during hospitalization,mortality,and the incidence of severe（grade III/IV） intraventricular hemorrhage（IVH）,bronchopulmonary dysplasia（BPD）,retinopathy of prematurity（ROP）,patent ductus arteriosus（PDA）,and septicemia.Results Among the 90 extremely preterm infants,the gestational age,birth weight,overall survival rate,mortality,and withdrawal rate were 26±1 weeks,898±165 g,57%,9%,and 34%,respectively.The incidence rates of neonatal respiratory distress syndrome,BPD,PDA,ROP,and grade III/IV IVH were 88%,85%,69%,68%,and 31%,respectively.The surviving infants had a mean length of hospital stay of 83±18 days and a mean weight at discharge of 2 419±300 g.The multivariate logistic regression analysis showed that grade III/IV IVH and pulmonary hemorrhage were high-risk factors for death or withdrawal,while antenatal corticosteroids were the protective factor for outcome（P＆lt;0.05）.Conclusions The survival rate of extremely preterm infants is still much lower than that in developed countries.grade III/IV IVH,and pulmonary hemorrhage are important prognostic factors.[Chin J Contemp Pediatr,2014,16（6）： 596-600]

关 键 词：胎龄 存活率 产前激素预后 超未成熟儿 

分 类 号：R722.19[医药卫生—儿科]